What is a Reverse Total Shoulder Arthroplasty? (RTSA)

Annually, thousands of conventional total shoulder replacements are successfully done for patients with shoulder arthritis.

However, conventional shoulder replacements are not as beneficial for patients with large rotator cuff tears or patients who have developed a complex type of shoulder arthritis known as “cuff tear arthropathy.” For these patients, reverse total shoulder arthroplasty is a better option, allowing for more range of motion and less pain. 

A conventional shoulder replacement recreates the normal anatomy of the shoulder: a plastic “cup” is fitted into the shoulder socket and a metal ball is attached to the top of the upper arm bone (the humerus). However, in a reverse total shoulder arthroplasty, the socket and metal ball are switched. The metal ball is fixed to the socket and the plastic cup is fixed to the upper end of the humerus. This means the natural position is reversed. 

A reverse total shoulder arthroplasty is a better option for patients with cuff tear arthropathy because it uses different muscles to move the arm. In a healthy shoulder, the rotator cuff muscles help position and move the arm in a complete range of motion. A conventional replacement device uses the same rotator cuff muscles to function properly. However, in a patient with a large rotator cuff tear or cuff tear arthropathy, the rotator cuff muscles no longer function. A reverse total shoulder replacement instead uses the deltoid muscle, instead of the rotator cuff, to power and position the arm. 

What injuries lead to this procedure?  

Shoulder injuries are common in physically demanding jobs, such as construction or jobs requiring repetitive movements, heavy lifting, or strenuous overhead work. Pushing, pulling, falling on the shoulder, and blunt trauma to the joint can also cause injuries resulting in decreased range of motion, numbness, tingling, and stiffness of the shoulder. Fractures and rotator cuff tears are two of the most common shoulder injuries to the shoulder. 

Other shoulder injuries include dislocation, severe shoulder strain, tendonitis, bursitis, or overuse injuries. The pain and loss of motion caused by osteoarthritis, post-traumatic arthritis, rotator cuff arthropathy, or a severe shoulder fracture can also make patients good candidates for reverse total shoulder arthroplasty.

Signs you need the surgery 

Reverse total shoulder arthroplasty may be recommended if you have: 

• A completely torn rotator cuff that cannot be repaired
• Cuff tear arthropathy
• A previous shoulder replacement that was unsuccessful
• Severe shoulder pain and difficulty lifting your arm away from your side or over your head 
• A complex fracture of the shoulder joint 
• A chronic shoulder dislocation
• A tumor in the shoulder joint
• You’ve tried other treatments, such as medications, cortisone injections, and physical therapy, that have not relieved your shoulder pain or increased your range of motion.

What to Expect

The reverse total shoulder arthroplasty surgery is very similar to that of a regular shoulder replacement with a few variations. Your surgeon will make an incision either on the front or the top of your shoulder. The surgeon will remove the damaged bone and position the new artificial components to restore function to your shoulder. 

The surgery is typically done with a nerve block of the arm and a general anesthetic. The procedure takes about two to three hours. Most patients can begin moving the fingers, wrist, and elbow the next day. 

Patients with an ongoing infection in the shoulder should not have a reverse total shoulder arthroplasty until the infection is completely clear. This should be discussed in detail with your surgeon prior to having this procedure done. 

Long term expectations of the surgery

After post-operative rehabilitation, you will most likely be able to lift your arm to just above shoulder height and bend your elbow to reach the top of your head. Reverse total shoulder arthroplasty provides excellent pain relief, and patient satisfaction is typically very high. The degree of pain relief depends largely upon the reason the procedure was done. Talk to your doctor to find out if reverse total shoulder arthroplasty is the best option to relieve your shoulder pain and restore mobility to the arm.